We are an equal opportunity employer.  All applicants are considering without regard to race, color, disability, sex, national origin, age (for those age 40 or over), or any other basis protected by federal, state, or local law.  This employment application is only active for 30 days.  After this time period a separate employment application must be submitted in order to be considered for employment.  Please know this information is solely intended for the use of A-ALL financial and will not be shared with third parties.  
 
PERSONAL  
 
Date
 
First Name Middle Name Last Name
 
Street Address Social Security No.
 
City State Zipcode
 
Phone No. Email
 
How did you find out about this job? 
 
If hired, do you have reliable means of transportation to get to work? Yes No  If Yes, What is it? 
 
Minimum salary expected Are you at least 18 years old?   Yes    No 
 
If the job you are applying for requires driving:  Yes    No 
 
Driving License No. State Issued: Expiration Date:
 
Are you legally eligible for employment in the U.S.?  Yes    No   (Proof of U.S. citizenship or immigration status will be required if hired.)
 

 
EMPLOYMENT DATA  
 
Are you seeking:      What position(s) are you applying for?  
 
What hours and shift(s) would you prefer to work?
 
Are you willing to work a flex schedule?    Yes    No 
 
Please indicate what shift(s) would you not be available to work:
 
Are you willing to work overtime?    Yes    No 
 
Are you willing to work overnight?    Yes    No 
 
Are you willing to work weekends?    Yes    No 
 
Are you currently employed?    Yes    No  
 
If hired, when would you be able to start?   
 
Have you ever worked for this organization before?   Yes    No If yes, name used 
 
List any friends or relatives employed by this company  
 
Are you on layoff and subject to recall?   Yes    No 
 
Have you ever been discharged or asked to resign from any position?  Yes    No
 
If yes, please describe: 
 
How many days have you missed from school or work within the last year other than approved vacation, sick, or disability leave?  
 
How many days have you been late to school or work within the last year other than approved vacation, sick, or disability leave?   
 
Please describe the type of business and what tasks might be required of you for the position in which you have applied. Are you able to perform these tasks with or without reasonable accommodation? Yes    No
 
Comments
 
Please describe which tasks, if any, you will need an accommodation to perform, and explain what type of accommodation you will need to perform:
 
 
Comments
 
Please describe your current computer knowledge and abilities: Mark all programs you are familiar with Microsoft.
 
 Word   Excel   Outlook   Powerpoint  
 
Comments

 
EDUCATION (Select highest level attained.)  
 
Elementary   1    2    3    4    5    6    7    8  
 
Secondary   9     10     11     12     GED   
 
College   1    2    3    4    5    6    7    8  
 
Name of School       Name of School       Name of School      
 
Location of School   Location of School   Location of School  
 
Degree and Major   Minor   
 
If currently in high school, are you enrolled in a recognized co-op program?  Yes    No
 
If yes, identify program and School:  
 

 
MILITARY SERVICE
 
Are you a veteran?   Yes    No
 
If yes, give dates of service: From     To  
 
List any special skills or training:
 

 
WORK HISTORY (Please list your last four employers. Begin with the most recent.)
 
CompanyPhone No. with area code
 
Street Address
 
City State Zipcode
 
Dates of Employment: From To: 
 
Salary: Beginning:    Ending:   
 
Job Title:   Supervisor's Name and Title:    
 
Describe duties briefly: 
 
Specific reason for leaving:  
 

 
CompanyPhone No. with area code
 
Street Address
 
City State Zipcode
 
Dates of Employment: From To: 
 
Salary: Beginning:    Ending:   
 
Job Title:   Supervisor's Name and Title:    
 
Describe duties briefly: 
 
Specific reason for leaving:  
 

 
CompanyPhone No. with area code
 
Street Address
 
City State Zipcode
 
Dates of Employment: From To: 
 
Salary: Beginning:    Ending:   
 
Job Title:   Supervisor's Name and Title:    
 
Describe duties briefly: 
 
Specific reason for leaving:  
 

 
CompanyPhone No. with area code
 
Street Address
 
City State Zipcode
 
Dates of Employment: From To: 
 
Salary: Beginning:    Ending:   
 
Job Title:   Supervisor's Name and Title:    
 
Describe duties briefly: 
 
Specific reason for leaving:  
 

 
May we contact all of the employers listed above?  Yes    No
 
If not, tell us which one(s) you do not wish us to contact and why: 
 
How many jobs have you had in the last five years not listed above? 
 
Why are you seeking a new position at this time? 
 
Why do you think you might like working for this organization? 
 
List any business-related outside interests and organizations you're active in:
 
 
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